Sensory Processing, Sensory
Integration, Regulatory Disorder
What are these and why do we care?
Toby Long, PhD, PT, FAPTA
Georgetown University
Center for Child and Human Development
October 19, 2012
Todays Workshop
Today evening we will discuss the concept of
sensory processing and how children (and
adults) perceive, process, and use sensory input
during everyday interactions. We will also
discuss some of the consequences when
children’s interpretation of sensory input leads
to undesirable behavior. Strategies that are easy
to incorporate into everyday activities and
classroom routines will also be discussed.
Speaker
Toby Long, PhD, PT, FAPTA is an Associate Professor in the Department of Pediatrics,
Georgetown University and the Training Director of the Center for Child and Human
Development, University Center for Excellence in Developmental Disabilities. Dr. Long
is the Director of the Graduate Certificate Program in Early Intervention offered by
Georgetown University and teaches Children with Disabilities, within the
undergraduate Minor in Education, Inquiry and Justice. Dr. Long is also the Director of
the Comprehensive System of Personnel Development for the District of Columbia’s
early intervention program, Strong Start.
She is a Professor of Physical Therapy at the Krannert Graduate School of Physical
Therapy at the University of Indianapolis, and Rocky Mountain University of Health
Professions. Dr. Long is an internationally known speaker and consultant on service
delivery to children with disabilities and special health care needs. She is the author
of multiple publications including The Handbook of Pediatric Physical Therapy, Second
Edition. The recipient of a variety of awards, Dr. Long is a Catherine Worthingham
Fellow of the American Physical Therapy Association.
She can be reached at longt@georgetown.edu
Agenda
Differentiate sensory processing, sensory
integration, and regulation
Discuss relationship between sensory
processing/regulation and development
Discuss tools used to identify sensory
processing challenges in your children
Discuss strategies that promote functional
sensory processing and regulation
For Now and Forever
What are your hopes and dreams for the young children
in your life?
They have
friends
They are
successful
They are
happy
How do we become happy &
successful with good friends ?
Opportunities to participate in community
based activities
Use developmental strengths functionally
•
•
•
•
Social and emotional
Cognition
Language
Motor
Use compensations, modifications,
accommodations as needed
What may prevent us from becoming
happy & successful?
Disability
• ASD
• Development
al delay (esp.
language)
• Physical
disability
Behavior
• ADHD
• OCD
• Depression
• Bi-polar
• Aggression
• Noncompliance
Family
Society
• Maternal
depression
• Harsh parenting
• Stressful family
life
• Low social
support
• Family instability
• Lack of
accommodation
• Attitudes
• Lack of
knowledge
• Intolerance
Sensory Processing, Sensory
Integration, and Regulatory Disorder
Learning and healthy behavior is influenced by
 How we experience sensory input from the
environment
 How we interpret that input
 How we organize it
 How we use it
How we PROCESS, INTEGRATE, REGULATE and USE
sensation
Processing, Integrating, Regulating
allows us
• Explore and play
• Complete every day
activities
• Be available for learning
• Maintain focus and
attention
• Manage our emotions
Apply this to your life?
Perceive
Sense
Perform
Recall
Do
Remember
Plan
Think
Sensory Processing
 Effective Sensory Processing
The ability of the central
– leads to a response that is
nervous system to receive
appropriate or well matched
to the situation!
sensory information,
Sensory
interpret that information,  Ineffective
Processing
and make a behavioral
– leads to a response that is not
appropriate.
response that is consistent
http://www.youtube.com/watch?v=6O
with the sensory
6Cm0WxEZA
information
What does recent research tells us
• 2004: 1 in 20 children were affected by SPD (Ahn, Miller, Milberger,
McIntosh)
• 2007: Children with ASD scored significantly poorer on all
aspects of Short Sensory Profile (Tomchek & Dunn, 2007)
• 2009: 1 in 6 children have sensory challenges sufficient to
disrupt academic, social, &/or emotional development (BenSasson, Carter, Briggs-Gowen)
• 2011: 2 Subtypes of SPD/SMD identified:
– sensory seeking, hyperactive, impulsive, aggressive
– movement sensitivity, emotionally withdrawal, and low
energy/weak behavior (James, Miller, Schaaf, Nielsen, Schoen)
• 2011: Sensory over responsiveness correlates with
negative temperament and fear in 2 y.o.(Keuler, Schmidt, Van Hulle,
Lemery-Chalfant, Goldsmith)
Sensory Processing Profiles
Sensory Seeker
Sensory Avoider
Sensory Sensor
Sensory Bystander
Seeker
•
•
•
•
Active, engaging, disruptive
Requires novelty
Fidgets, explore objects
Constantly increasing sensory input
Avoider
•
•
•
•
•
Limits sensations
Disruptive
May have routines, rituals, rules
Rigid
Avoids or withdraws
Sensor
•
•
•
•
Aware of surroundings
Distractible
May be hyperactive
Difficulty maintaining attention
Bystander
•
•
•
•
Appears disinterested
Low energy levels
Appears self-absorbed
Flat affect
So what profile are you???
Long, 2009
Ryder (Pathways Awareness Foundation)
http://pathways.org/top/pathwaysvideos/sensory-integration-processing/
So what do we know about kids and SP
Infants
Fussy
Colic
Poor feeding
Intolerance to formula
Short sleep periods
Hyperalert
Arches away when held
Difficulty self calming
Toddlers
Preschoolers
Falls more often
Prefers soft foods (white diet)
Difficulty sleeping
Seems weak/low tone
Lethargic
Doesn’t like finger foods
Clumsy
Difficulty using
crayons/arts and crafts
Bumps into things and
people
May get to close
Argues
Difficulty with dressing
Unintentionally aggressive
What do we know about kids with certain disabilities and SP?
Autism Spectrum
Disorders (ASD)
Social-Emotional
Difficulties (SED)
Infants with
Regulatory
Disorders
Attention Deficit
Hyperactivity
Disorder (ADHD)
ADL
Behavior
Crying
Picky eater
Dislike hair
brushing/hair
cuts/washing
Impulsive
Argue, Aggressive
Disruptive, Stubborn
Anxious, Depression
3 hours/day
High pitched
Start suddenly
Has frantic quality
Sensory
Learning
Sleep
Under responsive
Less sensory seeking
Distracted by noise
Inattention
May have cognitive,
language, motor
delays
Social
Short burst of sleeps
Awaken suddenly
Difficulty transitioning
to sleep
Inattentive
Disruptive
Impulsive
May have
behavior issue
Development
Few friends
Feeding
Motor planning
challenges
Language
Social interactions
Poor modulation of
language, behavior,
motor
ADL
Difficulty nippling
Intolerance to
formulas
Prefers soft/white
food
May have disruptive
sleep
May have food
preferences
Argue
Aggressive
Anxious
Depression
May have LD
Red Flags
Checklists
IT 3
Infant
Toddler
Sensory
Profile
• Early
Intervention
•
•
•
•
Red Flags
Checklists
IT 3
Infant
Toddler
Sensory
Profile
• Early
Intervention
Preschoolers
•
•
•
•
Toddlers
Infants
How we can we tell?
• Red Flags
• Screening
• Sensory
Profile
• Child Find
IT 3: Infant Toddler Temperament Tool
• Temperament: 9 common traits (handout)
Activity Level
Distractibility
Intensity
Regularity
Sensitivity
Approachability
Adaptability
Persistence
Mood
• Goodness of Fit: Compatibility between adult and
child
– Adults expectations and caregiving strategies match
child’s personal style (temperament)
http://www.ecmhc.org/temperament/IT3.php?infant
“Participation Period”
What will we learn?
 IT 3 : Goodness of Fit concerns
 Checklists: Child may have sensitivity to certain sense
–
–
–
–
–
–
–
Movement
Proprioception
Touch
Auditory
Taste
Smell
Visual
 Sensory Profile: Intensity of response to sensation: under  over
 How the sensitivity impacts every day expectations
So what do we do???
Long, 2009
Well-maybe not that
Sensory diets
– By Profile
– By Sense
Sensory friendly environments
– Accommodations
– Modifications
Routines
– Especially helpful for infants and toddlers
What does current research tell us
• 2002: Little evidence to effectiveness of sensory-motor
intervention for children with ASD (Baraneck)
• 2009: Behavioral strategies more effective than SI in
reducing self-injurious behavior in 9 y.o. children (Devlin,
Leader, Healy)
• 2010: No differences in preschool teacher assessment
of estimated percentages of time on-task with SI (Bonggat,
Hall)
• 2011: Social responsiveness, sensory processing,
functional motor skills, social emotional factors
improved more in 6-12 yo children with ASD receiving
SI than the fine motor only group although both groups
improved (Pfeiffer, Koenig, Kinnealey, Sheppard, Henderson)
Sooooooo
Evidence to support sensory modulation
and responsive differences in children
with a variety of challenges
Little evidence to support effectiveness
of intervention
No evidence indicating sensory motor
strategies are harmful
Seeker
•
•
•
•
Active, engaging, disruptive
Require novelty
Fidgets, explore objects
Constantly increasing sensory input
Avoider
•
•
•
•
•
Limits sensations
Disruptive
May have routines, rituals, rules
Rigid
Avoids or withdraws
Sensor
•
•
•
•
Aware of surrounds
Distractible
May be hyperactive
Difficulty maintaining attention
Bystander
•
•
•
•
Appears disinterested
Low energy levels
Appears self-absorbed
Flat affect
Sensory Diets
By Sense
Movement
Proprio.
Touch
Swinging
Toss infants in air (very gently!)
Use linear movement to rock
babies
Sit n Spin
Carry pot/pan
Wheel barrel walking
Wrap in blanket during TV
Wear a back pack
Crawl on hands and knees
Under tables
Push small grocery cart
Pop bubble wrap
Scrub with wash cloth during
bath time
Deep massage
By Profile
Seeker
Jumping games
Push pull games
Swinging, trampolines
Make a child sandwich
Red light-Green light
Sensor
Limit sensations during
interactions (only touch not talk)
Avoid heavy perfume,
detergents, spices
Maintain structure
Bystander
Actively encourage (not force)
Provide crunchy food to
increase alertness
Take stretch breaks
Avoider
Use slow, rhythmic movements
Play calming, gentle music
Quiet environment
Less distractions
Sensory Friendly Environments
De-clutter
 Maintain arrangement of furniture
– Unambiguous definition of spaces
 Keep noise level down: radio with gentle music rather than
TV or rock music
– Do NOT watch TV during meals or when you want to interact
– White noise can be calming
 Natural lighting as much as possible
 Maintain temperature between 68-72o
 Greens/blues are calming; reds/pinks alerting
 Keep an activity schedule posted and refer to it on a regular
basis
Direct Sensory-Motor Activities
Incorporated into Day
• Infant Position:
http://www.youtube.com/watch?v=M7J3w7opdUE
• Infant Massage
http://www.youtube.com/watch?v=clV2Ekn55c&feature=relmfu
• Infant Interaction/Bundling
http://www.youtube.com/watch?v=pA7vFgKuQdA
&feature=relmfu
• Preschoolers: Carol Kranowitz, The Out-of-SyncChild
Incorporating sensory input into daily
activities and routines
• Bath time: Scrub with washcloth or bath brush, try a variety of soaps and
lotions, play on the wall with shaving cream or bathing foam, rub body
with lotion after bath time (deep massage), sprinkle powder onto body
and brush or rub into skin.
• Meal preparation or baking: Let your child mix ingredients, especially the
thick ones that will really work those muscles. Let child mix and roll dough
and push flat. Allow child to help you carry pots and pans, bowls of water
or ingredients (with supervision, of course). Let your child tenderize meat
with the meat mallet.
• Grocery shopping: Have your child push the small cart. Let your child help
carry heavy groceries and help put them away.
• Mealtime: Encourage eating of chewy foods and drinking out of a straw.
Try having your child sit on an air cushion to allow some movement. A
weighted lap blanket may be helpful as well. NO TV
Some more routines…
• Household chores: Allow child to help with the vacuuming or moving the
furniture; help carry the laundry basket or the detergent; help digging for
gardening or landscaping.
• Play time:
– Reading books in a rocking chair or bean-bag chair may be calming.
– Make obstacle course in the house/ yard using crawling, jumping, hopping,
skipping, rolling, etc.
– Incorporate sensory activities into play
– Swimming, horseback riding, bowling, mini or full-size trampolines, sandboxes or
big containers of beans or popcorn kernels: add small cars, shovels, cups, etc.
• Errands and appointments: Before visiting dentist/hairdresser try deep
massage to the head or scalp or try having your child wear a weighted hat.
Try chewy foods or vibration to mouth with an electric toothbrush. Let your
child wear a heavy backpack or weighted vest.
– Give ample warning before any changes in routine or any unscheduled trips or
errands.
And more….
• Be consistent with rules and consequences
• Create specific routines for troublesome times of day
(bedtime or getting ready for school).
• Discuss upcoming anticipated changes in routine at a point in
time that is beneficial for your child. You will have to
experiment with how early the child "needs to know."
• Indirectly use sensory preferences for fun rewards.
– For example, having your child work towards an extra trip to go
bowling or horseback riding may be helpful.
– Try not to restrict movement activities or sensory preferences as
punishments. Your child may need that movement time, and by
removing it, his or her behavior may actually become more
difficult later.
Caregiver Strategies
You are an Important Person
in the Life of an Infant or Toddler
Connect With Families
Families have the most continuous and
emotionally charged relationship with the
child. Infants and toddlers learn what people
expect of them and what they can expect of
other people through early experiences with
parents and other caregivers. (Day & Parlakian, 2004)
 Learn about a families culture, traditions, beliefs and
dreams for their child.
 Share positive experiences
 Affirm parents, use reflective listening
“A good example has twice the
value of good advice” - author unknown
Provide Activities and Routines
 Use routines as a time to connect with children
 Maintain a predictable schedule
 Plan routines around each child’s needs and abilities
 Ensure time for quiet and active play
 Talk, read and sing with children every day
Provide Responsive Caregiving
 Hold, cuddle and rock children
 Respond to cues (coos, smiles, cries, etc)
 Talk to infants and toddlers about their emotions
 Stay close by as children interact with one another
 Observe each child’s skills
Provide Safe and Nurturing
Learning Environments
• Create a homelike environment
• Have duplicates of favored toys
• Display toys within reach
• Allow children to have and use comfort items
• Keep the room and materials safe
• Make sure there are enough adults to safely care for
children
Application
Summary
• All of us perceive sensory input differently
– That’s OK!
• Sometimes the way we respond to sensory input get’s in the way of
learning, interacting, and behaving
– That’s not OK!
• Strategies embedded into the daily routine are our first choice in
helping kids
– Some kids may need more
Key Resources
http://www.spdfoundation.net/whatweoffer.htm
www.STARCenter.us
http://out-of-sync-child.com/
www.teachingei.org
www.ecmhc.org